This invention relates generally to surgery and more particularly to improvements in instruments used for suction, irrigation, or both in surgical procedures, for example sinus surgery.
Sinus surgery is typically carried out with the aid of an endoscope. The endoscope is inserted into a patient""s nostril to enable the surgeon to observe a magnified view of the surgical field on a monitor connected to a video camera coupled to the endoscope. Nasal/sinus surgery is carried out in a confined, highly vascularized space. Therefore, there is significant splattering of blood and surgical debris onto the endoscope during the surgery. It is important to keep the endoscope lens clear of blood and surgical debris for optimal visualization of the surgical field. Typically, this is accomplished by irrigating the lens of the endoscope or by removing the scope from the nostril for manual cleaning.
The patient is normally under general anesthesia and in a supine position. The telescope is inserted into the nostril and manipulated to position the tip of the scope near the surgical site. The endoscope is typically handled by the surgeon using a finger grip in order to control the position of the endoscope against the forces exerted by the tissue structures and the attachments to the endoscope, such as a video camera head and cables, a fiber optic light carrier and irrigation tubes. This method of handling the endoscope has been found to cause fatigue, especially in longer surgical procedures.
Another problem encountered in conventional endoscopic sinus surgery is encumbered working space. The typical method of gripping the endoscope can limit the working space around the scope for the manipulation of other instruments. This encumbrance is increased when irrigation tubing and/or bulky hand pieces take space around the entrance to the nostril.
Existing pump-driven irrigation systems have foot-operated controls. Locating these controls among other foot-operated equipment, such as the electrosurgical unit and powered cutting devices, is distracting to the surgeon during surgery, since the surgeon must shift his or her position to operate the various controls. These devices are also cumbersome to set up and generally do not provide adequate fluid volume and pressure.
It is an object of this invention to address the aforementioned problems, and it is a general object of this invention to provide an ergonomically superior irrigation system for use in sinus surgery and in other surgical operations where irrigation and/or suction are required.
A preferred endoscopic instrument in accordance with the invention comprises a tubular sheath extending along a sheath axis, the sheath having an internal passage for receiving a telescope, the internal passage extending from a proximal, telescope-receiving opening to a distal tip, and a port for connection to suction and irrigation lines; a handle having a manually graspable external surface; a suction valve within the handle, the suction valve being connectible to a suction line and openable to provide communication between said port and the suction line; an irrigation valve within the handle, the irrigation valve being connectible to an irrigation line and openable to provide communication between said port and the irrigation line; manually operable controls on the handle for selectably opening the suction and irrigation valves; and a coupling rigidly connecting the handle to the sheath at an intermediate location along the length of the sheath between the proximal opening and the distal tip; wherein the handle is elongated along a handle axis and oblique relative to the sheath. Preferably, the coupling permits adjustment of the angle between the handle and the sheath. The sheath is releasably locked to the coupling, and rotatable, when released, about the sheath axis. The rotatability of the sheath allows for appropriate positioning of an angle or side-viewing telescope.
Other objects, details and advantages of the invention will be apparent from the following detailed description when read in conjunction with the drawings.